Do we accept Extended Health Insurance and Employee Benefits? Yes we do!
As a courtesy, our clinic offers to submit direct payment claims to the following extended health insurance companies:
Chambers of Commerce Group Insurance
Cowan Insurance Group
Equitable Life of Canada
First Canadian Insurance Corp.
Green Shield Canada
Johnston Group Inc.
Manion Wilkins & Associates
Medavie Blue Cross
Sun Life Financial
We offer the convenience of direct payment claims submissions online to these companies, to applicable policies which permit it. Please note that not all policies are the same, even within the same company. Your insurance policy may feature one or more of the following restrictions on your coverage:
Partial Coverage – if insurer pays less than 100% of the service fee, you as the plan member are responsible for payment of the remainder
Annual Deductible – the plan member is responsible for payment of the deductible amount
Payment Directly To Insured Member – the clinic’s submission of claims online only is done as a courtesy, and will only be performed for these plans if a credit card is provided by the plan member to be stored securely on file to pay for services rendered. Desjardins Insurance plans are strictly of this type.
Manual Submission Only – a restricted policy requiring manual/paper submission of paid receipts by the plan member, for direct reimbursement from the insurer to the plan member. The clinic will provide receipts for this purpose upon their full payment by the plan member. Please note that plans with Local 183 and TTC are nearly all this type.
Coverage Limited to Set Amount Per Visit – your insurer may cover to a pre-determined dollar limit per session or visit, which may or may not depend on the service type or practitioner type.
Please be aware that every insurance policy is unique with regards to these above features, as well as with regards to their annual limits per practitioner type, which is a discussion beyond the scope of this article. It is ultimately the insured member’s responsibility to be aware of and familiar with their own insurance coverage details, which includes but is not limited to coverage limits or other requirements such as prescriber notes for services such as massage therapy, physiotherapy or others, if applicable.
Because an insurance policy is an agreement between an insurance company and you as its insured member only, there is no obligation nor responsibility for the clinic and its providers to be involved in that agreement. The ultimate responsibility to pay for services rendered by clinic practitioners and received by an individual insured member or dependent on their policy rests with that insured member. The clinic will not track your claims submitted against your coverage limits. That is your responsibility as plan member should that be your concern. The clinic will notify you of full or partial payment by the insurer due to plan limitations or annual limits which would require your attention for any remaining payment due.
The clinic will not engage in fraudulent billing practices to the unfair, unlawful benefit of any patient or client as an insured plan member. The clinic will not submit false claims under a spouse or other family member’s name. The clinic will not submit a false claim that does not match the service rendered, the date is was rendered, nor the practitioner providing that service. The clinic will not bill for any amount different than the posted fees. The clinic will not accept an insurance policy’s partial coverage or partial payment and consider it as full payment.